Download Cancer in Alberta - Alberta Health Services

2012 Report on
Cancer Statistics in
Alberta
Cancer in Alberta
Surveillance & Reporting
CancerControl AB
February 2015
Acknowledgements
This report was made possible through Surveillance & Reporting, Cancer Measurement
Outcomes Research and Evaluation (C-MORE), CancerControl AB, Alberta Health Services,
and the many contributions of individuals across Alberta Health Services as well as external
agencies and individuals.
The authors wish to thank individuals working in the following AHS departments and partner
agencies for their contributions to this report: Alberta Cancer Registry; Population, Public and
Aboriginal Health; Alberta Health and Statistics Canada. Contributions included provision of
information, analysis and interpretation, and assistance with consultation sessions and
communication of the report.

Report Editor:
Dr. Lorraine Shack, Director, Surveillance & Reporting

Project Coordinator:
Bethany Kaposhi, Epidemiologist

Analysis and Review:
Dr. Zhenguo Qiu, Biostatistician
Li Huang, Senior Surveillance Analyst
Jingyu Bu, Senior Surveillance Analyst
Anthony Karosas, Surveillance Analyst
Andrew Min, Assistant Programmer Analyst
Lee-Anne Weeks, Analyst
Michael Taylor, Senior Analyst
Shuang Lu, Senior Surveillance Analyst
Ting Liu, Programmer

Design Assistance:
Kira Kulicki, Communications Coordinator, Alberta Cancer Clinical Trials
Suggested Citation:
Surveillance & Reporting: 2012 Report on Cancer Statistics in Alberta. Edmonton:
CancerControl AB, Alberta Health Services, 2015.
For More Information:
Visit our website: http://www.albertahealthservices.ca/1703.asp
2012 Report on Cancer Statistics in Alberta
2
Table of Contents
Purpose of the Report ................................................................................................................................ 4
Navigating the Report ................................................................................................................................. 4
Data Notes.................................................................................................................................................... 4
Summary ...................................................................................................................................................... 5
Cancer in Alberta ........................................................................................................................................ 6
Demography of the Alberta Population .................................................................................................... 7
Causes of Death in Alberta ...................................................................................................................... 10
Potential Years of Life Lost ...................................................................................................................... 12
Probability of Developing or Dying from Cancer ................................................................................... 16
Incidence and Mortality ............................................................................................................................ 19
Cancer Survival ......................................................................................................................................... 34
Geographic Variation ................................................................................................................................ 39
Further Information ................................................................................................................................... 44
References ................................................................................................................................................. 45
Contact Information .................................................................................................................................. 46
2012 Report on Cancer Statistics in Alberta
3
Purpose of the Report
Surveillance & Reporting, a specialized team within Cancer Measurement Outcomes Research and
Evaluation (C-MORE), Alberta Health Services, actively contributes to Changing our Future: Alberta’s
Cancer Plan to 2030. As well, Surveillance & Reporting keenly contributes to the goal of making Alberta a
place where most cancers are prevented, more cancers are cured, and suffering is reduced. This is
accomplished in part by conducting cancer surveillance through the collection, integration, analysis, and
dissemination of cancer-related data and information.
The report is designed to provide comprehensive and detailed information regarding cancer in Alberta. It
will help support health professionals, researchers and policy makers in the planning, monitoring and
evaluation of cancer-related health programs and initiatives. It will also be a useful education tool for the
general public and media.
Navigating the Report
This document provides information on cancer statistics in Alberta. Details about individual cancer types
are available within separate documents. The words highlighted in dark blue are terms described in
detail in the Glossary within the Appendix document.
Data Notes
In this document, the term “cancer” refers to invasive cancers unless otherwise specified. It is important
to note that this document contains both actual and estimated data; distinctions are made where
applicable. The numbers published in this report should be considered accurate at the time of publication,
as a few cases and deaths may be registered in subsequent years. The data in this report reflect the state
of the Alberta Cancer Registry as of July 14, 2014.
Incidence rates presented in this document exclude basal and squamous skin cancer cases which
together are commonly known as non-melanoma skin cancer. Although approximately 30% of the
malignant cancers diagnosed among Albertans each year are basal and squamous skin cancers, these
tumours are generally not life-threatening and are inconsistently reported and coded across registries;
therefore basal and squamous skin cancers are rarely included in cancer registry reports.
For detailed descriptions about data sources and how they affect data presented in this report, please see
the Appendix document.
2012 Report on Cancer Statistics in Alberta
4
Summary

Approximately 1 in 2 Alberta residents will develop cancer in their lifetime and approximately 1 in
4 people born in Alberta will die from cancer. Survival after diagnosis has improved over time
resulting in more individuals alive with a prior cancer diagnosis.

As of December 31, 2012, approximately 131,550 Albertans were alive who had previously been
diagnosed with cancer.

Overall cancer incidence has increased over the last 21 years. In 2012, the most recent year
available, there were 16,330 new cancer cases diagnosed in Alberta and 5,817 Albertans died
from the disease. The most commonly diagnosed cancers were breast, prostate, lung and
colorectal. These four cancers combined accounted for 52% of new cancer cases and about half
of cancer deaths.

Cancer accounted for 27% of deaths in the province for all ages in 2012 making cancer the
second leading cause of death in Alberta after deaths from circulatory system diseases (30%).
Among Albertans aged 35-64 years it accounted for 35% of deaths which is more than circulatory
system, respiratory system and digestive system diseases combined.

Potential years of life lost (PYLL) is the number of years of life lost when a person dies
prematurely from any cause, based on their life expectancy. In 2012, cancer was the leading
contributor to PYLL, representing about 28% of the total PYLL. Lung and bronchus, colorectal,
breast and pancreatic cancers accounted for the most PYLL.

Approximately 19,500 cases of cancer are expected to be diagnosed in 2017. This is a 125%
increase in the number of cancer cases between 1992 and 2017. Of this 125% the majority is
estimated to be attributed to an aging population (61%) and population growth (60%). Cancer is
more common later in life so as the average age of the population increases, there will be more
cancer cases. There is expected to be a small increase (3%) due to an increase in the incidence
rate.
2012 Report on Cancer Statistics in Alberta
5
Cancer in Alberta
Cancer is a group of more than 200 different diseases that are characterized by abnormal cells in the
1
body that divide and spread without control.
Cancer is a significant health issue that affects a large number of people in Alberta. In 2012 there were
16,330 cancer cases diagnosed in Alberta and 5,817 Albertans died from the disease. According to the
most recent statistics available from the Government of Alberta, 27% of all deaths in Alberta in 2012
2
were attributable to cancer. For those 35-64 years of age, 35% of deaths were due to cancer; more than
deaths from circulatory system disease, respiratory system diseases and digestive system diseases
combined.
In order to develop a clear understanding of the effect of cancer on the population in the province, it is
important to consider the numbers of people affected, their age and sex, and also where people live in the
province. This can be done through an assessment of the burden cancer imposes on our population (New
Cancer Cases, Cancer Deaths, Lifetime Probability of Developing or Dying from Cancer) as well as
through an examination of the size and structure of the Alberta population (Demography). It is also
important to evaluate the extent to which various types of cancers contribute to the overall cancer burden
(New Cancer Cases by Site, Cancer Deaths by Site, Potential Years of Life Lost and Cancer Prevalence).
Provincial cancer statistical information (Incidence and Mortality Trends, Cancer Projections, Relative
Survival and Incidence of Selected Cancer Sites by Zones) helps health professionals develop screening,
prevention and treatment programs that can lessen the effect of cancer on the population.
The following sections will outline all of these points in detail.
2012 Report on Cancer Statistics in Alberta
6
Demography of the Alberta Population
Demography is the study of population characteristics including population size, distribution, structure and
change. Estimation of changes in the size and age structure of a population over time can help predict
trends in the number of cancer diagnoses over time. Even if cancer rates remained constant, as the
population of Alberta increases due to immigration and population growth (births), a rise in the total
number of people diagnosed with cancer would be expected. Higher overall cancer incidence counts
would also be expected as the proportion of the population within older age groups increases because
many cancers occur more frequently in older age groups.
Figure 2-1: Historical (1992), Actual (2012) and Projected (2032) Population Structure by Age
Group and Sex, Alberta
Data Source: Alberta Health
3
Comparing population estimates in 1992 and 2012 with projections for 2032 shows that the population of
Alberta is aging (Figure 2-1).
2012 Report on Cancer Statistics in Alberta
7
Population size
The population of Alberta has increased 48% over the past 20 years from 2.6 million in 1992 to 3.9 million
in 2012. This growth is expected to continue over the next two decades and by 2032, the population is
4
expected to increase an additional 32% to approximately 5.1 million.
Population structure
The percentage of the population aged 65 and over has increased from 9% in 1992 to 11% in 2012. This
older adult age group is expected to also increase to 19% of the total population in 2032. The proportion
of the Alberta population aged 35-64 has increased in the last twenty years; in 1992, 35-64 year olds
made up 34% of the population and in 2012 they made up 41% of the total population. The proportion of
the population in this age group is expected to remain fairly constant over the next 20 years. In 1992, the
median age of the population was 31 years. The median age of the population rose to 36 years in 2012
(Table 2-1) and is expected to increase to 42 years by 2032.
Table 2-1: Population, Mean Age, Median Age and Interquartile Age Range across Health Zones,
Alberta, 2012
35
25th
Percentile Age
19
75th
Percentile Age
55
37
36
20
52
458,639
38
37
19
55
Edmonton
1,222,322
37
36
21
53
North
459,146
35
33
18
51
Alberta*
3,888,548
37
36
20
53
Zone
Population
Mean Age
Median Age
South
292,483
37
Calgary
1,455,958
Central
Data Source: Alberta Health
* Zone populations may not add up to the Alberta provincial population total due to lack of Zone assignments for some
individuals in the Alberta population data used for these estimates.
In 2012, the North Zone had the youngest age distribution with a median age of 33 years, 25% of the
population younger than 18 years of age, and 25% of the population older than 51 years of age. Central
(37 years), Calgary and Edmonton zones (36 years each) had the highest median ages with 25% of the
population younger than 20 years for Calgary zone, 21 years for Edmonton zone, and 19 years for
Central zone. For Calgary and Edmonton zones 25% of the population was older than 52 years and 53
years respectively.
The South Zone had a median age of 35 years but a wider distribution of ages with 25% of the population
younger than 19 years and 25% of the population older than 55 years. This compares to 25% of the
overall Alberta population being younger than 20 years and 25% of the total population being older than
53 years (Table 2-1).
2012 Report on Cancer Statistics in Alberta
8
Figure 2-2: Trends in New Cases Attributed to Aging Population, Population Growth and Cancer
Rate, Both Sexes, Alberta, 1992-2017
25,000
19,550
(125%)
New Cases
20,000
15,000
Aging
Population
(61%)
8,681
(0%)
Population
Growth
(60%)
10,000
Change in Rate
(3%)
5,000
0
Year
Number of Cases in 1992
Change in Rate
Population Growth
Aging Population
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Changes in demography in Alberta (aging of the population and population growth) contributed far more
new cases of cancer over the last two decades as compared to the minor change in the cancer rate
(Figure 2-2).
The horizontal black line in Figure 2-2 represents the 8,691 new cancer cases that occurred in 1992. In
2017, approximately 19,550 new cancer cases are projected to occur, accounting for a 125% increase in
cases from 1992. The line at the top of the dark purple-shaded area of the graph represents the number
of new cases that actually occurred between 1992 and 2012, projected to 2017. Between these two
lines, the three colored areas reflect the increase in cases due to the impact of rate change, population
growth and aging population.
The light blue shaded area (lower) represents the total number of new cases that would have occurred
each year if the cancer incidence rates alone had changed but the population had remained the same as
in 1992. This will account for approximately 3% of the total increase in new cancer cases in 2017.
The light purple shaded area (middle) represents the number of new cases that would have occurred
each year if the population alone had grown larger but the population age distribution had remained the
same as in 1992. This will account for approximately 60% of the total increase in new cancer cases in
2017.
The dark purple shaded area (top) represents the number of new cases attributed to increases in the
older adult population - the aging population. This will account for approximately 61% of the total
increase in new cancer cases in 2017.
2012 Report on Cancer Statistics in Alberta
9
Causes of Death in Alberta
Cancer is one of the leading causes of death in Alberta; over a quarter of the deaths in the province in
2012 were due to cancer. Figure 2-3 and Figure 2-4 compare cancer-related deaths and deaths from
other causes in Alberta.
‡
Figure 2-3: Leading Causes of Death in Alberta, All Ages, Both Sexes, Alberta, 2012
Other 11%
4% Digestive System Diseases
4% Nervous System Diseases
6% Mental and Behavioural Disorders
Circulatory System Diseases 30%
9% Respiratory System Diseases
Cancer 27%
9% Injury
Data Source: Health Status Assessment, Alberta Health Services; Alberta Vital Statistics, Government of Alberta 2.
‡
Proportions may not add up to 100% due to rounding.
2
According to the most recent statistics available from the Government of Alberta (Figure 2-3), 27% of
deaths in Alberta for all ages in 2012 were attributable to cancer, 30% were attributable to circulatory
system diseases and 9% to injury. All other causes combined accounted for the remaining 34% of all
deaths.
2012 Report on Cancer Statistics in Alberta
10
‡
Figure 2-4: Leading Causes of Death , Ages 35-64, Both Sexes, Alberta, 2012
Other 9%
3% Mental & Behavioural Disorders
3% Endocrine, Nutritional and Metabolic Diseases
5% Respiratory Sytem Diseases
Cancer 35%
6% Digestive System Diseases
18% Injury
Circulatory System Diseases
21%
Data Source: Health Status Assessment, Alberta Health Services; Alberta Vital Statistics, Government of Alberta2.
Proportions may not add up to 100% due to rounding.
‡
Although cancer is associated with aging, it is important to note that, for the 35–64 year age group
(Figure 2-4) cancer is the leading cause of death, accounting for 35% of all deaths, which is more than
deaths from circulatory system diseases, respiratory system diseases and digestive system diseases
combined.
2012 Report on Cancer Statistics in Alberta
11
Potential Years of Life Lost
One frequently used measure of premature death is potential years of life lost (PYLL), which is the
5
number of years of life lost when a person dies prematurely from any cause, given their life expectancy .
PYLL is calculated by taking the mid-point age in each age group, subtracting from the age and sexspecific, expected, Albertan life expectancy, and multiplying by the number of deaths in that age group
disaggregated by sex and cause of death to determine the years of life lost in each cohort (Figure 2-5).
The age and sex-specific life expectancy is calculated by determining the difference between the age to
which an individual would have been expected to live on average and the age they died at.
Figure 2-5: Selected Causes of Potential Years of Life Lost (PYLL), by Sex, Alberta, 2012
Cancer
46.6
Injury
46.6
47.4
Diseases of the Circulatory System
21.1
40.6
24.5
Male
Diseases of the Respiratory System
10.8
9.8
Female
50
40
30
20
10
0
10
20
30
40
50
PYLL (1,000 Person Years)
Data Source: Health Status Assessment, Alberta Health Services; Statistics Canada
The top four aggregated causes of premature death in Alberta in 2012 are represented by potential years
of life lost (PYLL) and are ranked in order of total PYLL for both males and females combined (Figure 25).
Overall, cancer was the leading contributor to PYLL, representing about 28% of the total PYLL in the
province. Injury was the second leading contributor to PYLL for males and females, representing about
21% of the PYLL resulting from all causes of death in Alberta.
2012 Report on Cancer Statistics in Alberta
12
Table 2-2: Potential Years of Life Lost by Cancer Site and Sex, Alberta, 2012
Cancer Site
All Cancers
Lung and bronchus
Colorectal
Breast
Pancreas
Brain
Prostate
Non-Hodgkin lymphoma
Leukemia
Stomach
Kidney and renal pelvis
Liver
Oral
Bladder (including in situ)
Esophagus
Ovary
Body of uterus
Multiple myeloma
Melanoma of the skin
Cervix uteri
Larynx
Thyroid
Testis
Hodgkin's disease
All Other Cancers
Both Sexes
Years
%
100
92,484
23.3
21,578
10.9
10,065
8.5
7,876
6.0
5,532
4.8
4,412
3.5
3,209
3.4
3,101
3.3
3,096
3.0
2,745
2.8
2,581
2.6
2,438
2.3
2,168
2.3
2,088
2.2
2,073
2.2
2,051
1.8
1,641
1.7
1,571
1.6
1,462
1.2
1,090
0.4
354
0.3
311
0.3
247
0.2
157
11.5
10,638
Male
Years
46,451
10,111
5,684
83
2,541
2,756
3,209
1,819
1,878
1,731
1,820
1,803
1,673
1,565
1,755
----795
976
--327
202
247
137
5,339
%
100
21.8
12.2
0.2
5.5
5.9
6.9
3.9
4.0
3.7
3.9
3.9
3.6
3.4
3.8
----1.7
2.1
--7.0
0.4
0.5
0.3
11.5
Female
Years
46,033
11,467
4,381
7,793
2,991
1,656
--1,282
1,218
1,014
761
635
495
523
318
2,051
1,641
776
486
1,090
27
109
--20
5,299
%
100
24.9
9.5
16.9
6.5
3.6
--2.8
2.6
2.2
1.7
1.4
1.1
1.1
0.7
4.5
3.6
1.7
1.1
2.4
0.1
0.2
--0.0
11.5
Note: Count and percentage totals may not add up due to rounding.
Data Source: Alberta Cancer Registry, Alberta Health Services.
The PYLL for cancer sites shown in Table 2-2 are ranked in decreasing order of total PYLL for both
sexes combined and are calculated based on the age-specific life expectancy at the time of death. Lung
cancer was the leading contributor to PYLL (21,578 years).
Even though pancreatic cancer comprised only 2% of the total cancer cases diagnosed in Alberta in
2012, it was the fourth highest contributor to PYLL (5,532) among all cancer sites. On the other hand,
prostate cancer is the second most commonly diagnosed cancer yet it was sixth on the list of PYLL
(3,209) attributable to cancer.
2012 Report on Cancer Statistics in Alberta
13
Figure 2-6: Potential Years of Life Lost by Top Six Cancer Sites, Both Sexes, Alberta, 2012
Potential Years of Life Lost (PYLL)
25,000
20,000
15,000
10,000
5,000
0
Lung
Colorectal
Breast*
Pancreas
Brain
Prostate
Cancer Type
*Female breast cancer only
Data Source: Alberta Cancer Registry, Alberta Health Services
The top six cancer sites in terms of potential years of life lost (PYLL) for both sexes in decreasing order
are lung, colorectal, breast, pancreas, brain and prostate (Figure 2-6). Deaths due to all cancers
resulted in 92,484 potential years of life lost in Alberta in 2012 (Table 2-2).
More years of life are lost due to cancers that are more common, have an earlier age of onset and/or are
generally diagnosed at a later stage of disease.
The PYLL due to the six types of cancer shown in Figure 2-6 account for 57.0% of the total potential
years of life lost due to cancer. Lung cancer alone was responsible for 21,578 PYLL, which represents
23.3% of premature mortality caused by cancer.
2012 Report on Cancer Statistics in Alberta
14
Figure 2-7: Potential Years of Life Lost by Top Six Cancer Sites and Sex, Alberta, 2012
14,000
Potential Years of Life Lost (PYLL)
12,000
10,000
Male
Female
8,000
6,000
4,000
2,000
0
Lung
Colorectal
Breast
Pancreas
Brain
Prostate
Cancer Type
Data Source: Alberta Cancer Registry, Alberta Health Services
The PYLL due to specific cancer types show that lung, colorectal and prostate were the top three cancers
in males responsible for PYLL, accounting for 40.9% of the total PYLL in males due to cancer (Figure 27). Although prostate cancer is more common than lung cancer among men, the PYLL due to lung cancer
is more than three times higher than that for prostate cancer, reflecting higher mortality rates for lung
cancer and the younger age at which males develop and die from this disease.
Among women, the top three cancers responsible for PYLL are lung, breast and colorectal, accounting for
51.3% of the total PYLL in females due to cancer (Figure 2-7).
2012 Report on Cancer Statistics in Alberta
15
Probability of Developing or Dying from Cancer
The probability of developing or dying of cancer measures the risk of an individual in a given age
range developing or dying of cancer, and is conditional on the person being cancer-free prior to the
beginning of that age range.
It is important to note that the probabilities of developing or dying of cancer represent all of Alberta’s
population on average and should be interpreted with caution at the individual level as the probabilities
will be affected by other risk factors relevant to the individual. In addition, someone diagnosed with cancer
6
has a higher probability of developing another cancer in the future.
Table 2-3: Lifetime Probability of Developing Cancer by Sex, Alberta, 2008-2012
Cancer Type
Males
Females
All Cancers (excluding NMSC)
1 in 2
1 in 2
Prostate
1 in 6
---
Less than 1 in 10,000
1 in 8
Lung and Bronchus
1 in 13
1 in 14
Colorectal
1 in 13
1 in 16
Breast
Body of Uterus
---
1 in 33
Non-Hodgkin's Lymphoma
1 in 39
1 in 46
Leukemia
1 in 42
1 in 65
Kidney and Renal Pelvis
1 in 55
1 in 85
Pancreas
1 in 67
1 in 61
Melanomas of the Skin
1 in 55
1 in 69
Bladder (including in situ)
1 in 23
1 in 81
---
1 in 77
Stomach
1 in 74
1 in 138
Thyroid
1 in 196
1 in 68
Oral
1 in 73
1 in 150
---
1 in 138
Multiple Myeloma
1 in 111
1 in 152
Brain
1 in 127
1 in 184
Esophagus
1 in 101
1 in 349
Liver
1 in 123
1 in 306
Larynx
1 in 206
1 in 1194
Ovary
Cervix Uteri
--- Not applicable
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
The probability of developing cancer differs by cancer site (Table 2-3). The probability of an Albertan
developing cancer within his or her lifetime is approximately 1 in 2.
A male is more likely to develop prostate cancer (1 in 6) than lung cancer (1 in 13); while a female in
Alberta is more likely to develop breast cancer (1 in 8) than lung cancer (1 in 14). Some cancers affect
2012 Report on Cancer Statistics in Alberta
16
one sex more than another, for example males are more likely to develop bladder cancer (1 in 23) than
females (1 in 81).
Table 2-4: Lifetime Probability of Dying from Cancer by Sex, Alberta, 2008-2012
Cancer Type
Males
Females
All Cancers
1 in 4
1 in 5
Lung and Bronchus
1 in 16
1 in 18
Prostate
1 in 26
---
Less than 1 in 10,000
1 in 33
Colorectal
1 in 32
1 in 38
Pancreas
1 in 77
1 in 71
Non-Hodgkin's Lymphoma
1 in 100
1 in 118
---
1 in 109
Leukemia
1 in 98
1 in 130
Stomach
1 in 106
1 in 192
Bladder (including in situ)
1 in 89
1 in 296
Kidney and Renal Pelvis
1 in 141
1 in 227
---
1 in 179
Brain
1 in 156
1 in 229
Esophagus
1 in 130
1 in 416
Multiple Myeloma
1 in 190
1 in 257
Oral
1 in 204
1 in 368
Liver
1 in 184
1 in 407
Melanomas of the Skin
1 in 302
1 in 566
---
1 in 498
Larynx
1 in 537
1 in 3115
Thyroid
1 in 2206
1 in 1233
Breast
Ovary
Body of Uterus
Cervix Uteri
--- Not applicable
Data Source: Alberta Cancer Registry, Alberta Health Services
Approximately 1 in 4 Albertans will die of cancer in their lifetime (Table 2-4).
Cancer site and sex affect the probability of dying from cancer (Table 2-4). A male in Alberta has a
higher chance of dying from lung cancer (1 in 16) than dying from prostate cancer (1 in 26). Similarly, a
female in Alberta today has a higher chance of dying from lung cancer (1 in 18) than dying from breast
cancer (1 in 33). A male has a higher chance of dying from kidney cancer (1 in 141) than a female (1 in
227).
It should be noted that common cancers do not necessarily have higher mortality rates. Even though a
female is more likely to develop breast cancer, breast cancer survival is higher than that of lung cancer.
2012 Report on Cancer Statistics in Alberta
17
Cancer Prevalence
The prevalence of a disease is defined as the number of people who are alive at a given point who had
been previously diagnosed with that disease.
Limited-duration cancer prevalence represents the number of people alive on a certain day who had
previously been diagnosed with cancer within a specified number of years (e.g. 2, 5, 10 or 20 years) while
complete cancer prevalence represents the proportion of people alive on a certain day who had
7
previously been diagnosed with cancer, regardless of how long ago the diagnosis was .
In this section of the report, both limited-duration and complete cancer prevalence are presented; the
latter describing the number of people alive as of December 31, 2012 who had ever been diagnosed with
cancer.
Prevalence is a useful indicator of the impact of cancer on individuals, the healthcare system and the
community as a whole. Although many cancer survivors lead healthy and productive lives, the
experience can have a strong impact on the physical and emotional well-being of individuals and their
families. The cancer experience can also result in the continued use of the healthcare system through
rehabilitation or support services, as well as loss of work productivity that can affect the whole community.
As of December 31, 2012, approximately 131,550 Albertans were alive who had previously been
diagnosed with cancer, out of which there were about 62,200 males and about 69,350 females (Table 25). In addition, there were 25,100 Albertans alive who had been diagnosed with cancer within the
previous two years. The two year time period is significant because most definitive cancer treatments will
occur within two years of diagnosis.
Table 2-5: Limited-Duration and Complete Prevalence for All Cancers*, Both Sexes, Alberta, 2012
Prevalence (#)
Duration
2-Year
5-Year
10-Year
20-Year
Complete (Ever diagnosed)
Both sexes
Males
Females
25,100
51,950
83,200
12,900
26,500
41,850
12,200
25,450
41,300
114,050
131,550
55,950
62,200
58,100
69,350
Data Source: Alberta Cancer Registry, Alberta Health Services
*Excluding non-melanoma skin cancer
2012 Report on Cancer Statistics in Alberta
18
Incidence and Mortality
Incidence counts are the number of new cancer cases diagnosed during a specific time period in a
specific population. In this section of the report, incidence counts refer to the number of new cancer
diagnoses in Alberta residents in a calendar year. Incidence rates are the number of new cancer cases
diagnosed per 100,000 in the population in a specific time period.
Mortality counts describe the number of deaths attributed to cancer during a specific period of time in a
specific population. In this section of the report, mortality refers to the number of deaths due to cancer in
Alberta residents in a calendar year, regardless of date of diagnosis. Mortality rates are the number of
deaths per 100,000 in the population in a specific time period.
In order to compare cancer incidence or cancer mortality over time or between populations, agestandardized incidence rates (ASIRs) or age-standardized mortality rates (ASMRs) are presented.
These are weighted averages of age-specific rates using a standard population. These rates are useful
because they are adjusted for differences in age distributions in a population over time, which permit
comparisons of cancer incidence or mortality among populations that differ in size, structure and/or time
period. ASIRs and ASMRs give the overall incidence and mortality rates that would have occurred if the
population of Alberta had been the same as the standard population. In this report the Canadian 1991
standard population is used.
Three-year moving averages are used to smooth out year-to-year fluctuations so that the underlying
trend may be more easily observed. They are calculated based on aggregating three years of data. Agestandardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) are presented as
three-year moving averages; therefore, information can only be presented for 1993-2011. This smoothing
of trends is especially important when the number of cancer cases per year is relatively small, where
year-to-year variability can be quite large.
Incidence and mortality can be affected by the implementation of public health prevention or screening
strategies that either prevent disease or find cancer in its early stages when treatment is generally more
successful, the development of cancer treatment programs that may impact chances of survival and
research innovations.
The following figures show incidence and mortality trends in Alberta. Separate analyses for both
incidence and mortality are shown in subsequent sections. The statistical significance* of the trends was
8
determined by using Joinpoint and is described in the text accompanying each graph. Joinpoint models
are based on yearly rates; hence there may be slight differences in the rates presented in the text (from
Joinpoint model) and the graphs (where ASIRs and ASMRs are shown as three-year moving averages).
Comparisons between Alberta Health Services cancer information and that of other organizations such as
the Canadian Cancer Society should be made with caution as methods differ for counting cases with
more than one primary cancer.
* Throughout this report, the use of the word significant refers to statistical significance at an alpha level of 0.05 (i.e.
95%CI).
2012 Report on Cancer Statistics in Alberta
19
Figure 2-8: New Cancers by Site (Percentage), Both Sexes, Alberta, 2012
14% Prostate
Lung 12%
14% Breast
Colorectal 12%
Bladder 5%
17% All Other Cancers*
2%
2%
Stomach
Non-hodgkin Lymphoma
4%
Melanoma
4%
Leukemia 3%
Oral
2%
Pancreas
Uterus
3%
3%
Thyroid
Kidney
3%
* All Other Cancers: comprised of all other cancer sites contributing to less than 2% of new cases individually
Data Source: Alberta Cancer Registry, Alberta Health Services
Breast, prostate, lung and colorectal cancers were the most frequently diagnosed cancers in 2012 in
Alberta, comprising 52% of all cancers diagnosed (Figure 2-8).
2012 Report on Cancer Statistics in Alberta
20
Figure 2-9: Cancer Deaths by Site (Percentage), Both Sexes, Alberta, 2012
22% All Other Cancers*
2%
Esophagus
2%
Liver
3%
Kidney
3%
Brain
3%
Bladder
3%
Stomach
4%
Non-hodgkin Lymphoma
4%
Leukemia
6%
Prostate
Lung 25%
Colorectal 12%
Breast
7%
Pancreas
6%
* All Other Cancers: comprised of unknown primary and all other cancer sites contributing to less than 2% of deaths
Data Source: Alberta Cancer Registry, Alberta Health Services
Lung, colorectal, breast and prostate cancers were responsible for 50% of cancer deaths in 2012 in
Alberta (Fig 2-9). Some cancers are not very common but, due to their poor prognosis, make a relatively
large contribution to mortality such as pancreatic, stomach, and brain cancers. These three cancers
combined were responsible for 12% of the cancer deaths in 2012 but less than 5% of newly diagnosed
cases. Lung cancer also has a poorer prognosis relative to other cancers: it accounts for 12% of new
cases but 25% of cancer deaths.
2012 Report on Cancer Statistics in Alberta
21
Table 2-6: Incidence and Mortality Counts by Cancer Type, Both Sexes, Males and Females,
Alberta, 2012
Cancer Type
†
All Cancers
Breast
Prostate Gland
Bronchus/Lung
Colorectal
Bladder
Non-Hodgkin Lymphoma
Melanoma of Skin
Leukemia
Body of Uterus
Kidney
Thyroid Gland
Pancreas
Oral
Stomach
Multiple Myeloma
Brain
Ovary
Esophagus
Liver
Cervix Uteri
Testis
Hodgkin's Disease
Larynx
All Other Cancers
Incidence Counts
Both
Males
Females
Sexes
16,330
8,481
7,849
2,346
13
2,333
2,338
2,338
-1,938
946
992
1,911
1,090
821
738
565
173
700
396
304
599
329
270
557
346
211
529
-529
483
320
163
480
128
352
380
172
208
378
275
103
256
159
97
209
127
82
201
113
88
196
-196
183
151
32
169
126
43
135
-135
117
117
-83
54
29
75
63
12
1,329
653
676
Mortality Counts
Both
Males
Females
Sexes
5,817
3,113
2,704
391
6
385
344
344
-1,428
730
698
683
378
305
170
130
40
213
120
93
72
46
26
214
127
87
87
-87
162
107
55
18
10
8
350
165
185
109
85
24
176
116
60
111
56
55
169
101
68
106
-106
125
106
19
130
95
35
35
-35
6
6
-6
5
<5
29
25
<5
683
355
328
† Incidence counts exclude non-melanoma skin cancer (basal and squamous)
-- Not Applicable
Data Source: Alberta Cancer Registry, Alberta Health Services
In Alberta, there were 16,330 cancer cases (excluding non-melanoma skin cancer) diagnosed in 2012
and 5,817 people died from cancer in that year. (Table 2-6). Lung cancer was the leading cause of
cancer deaths among both men and women. Prostate cancer was the most commonly diagnosed cancer
among men and breast cancer was the most commonly diagnosed cancer among women. Deaths that
occurred in 2012 include cancers diagnosed in 2012 or earlier.
2012 Report on Cancer Statistics in Alberta
22
*†‡
Figure 2-10: Age-Standardized Incidence Rates (ASIRs),
Age-Standardized Mortality Rates
*†
(ASMRs), and 95% Confidence Intervals (CI) for All Cancers, Both Sexes, Alberta,
1992-2012
600
500
Rate per 100,000
400
ASIR
300
ASMR
200
100
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Year
* Three-year moving average.
† Standardized to 1991 Canadian population.
‡ Excludes basal and squamous skin cancers
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
ASIRs of all cancers increased significantly between 1992 and 2002 by 0.9% annually and decreased
significantly between 2002 and 2012 by 0.7% annually (Figure 2-10). In 2012, the ASIR for all cancers in
both sexes was about 391.4 per 100,000 in the population.
Mortality rates are lower than incidence rates. ASMRs decreased significantly by 0.7% annually between
1992 and 2005, and by 2.2% annually between 2005 and 2012 (Figure 2-10). In 2012, the ASMR for all
cancers in both sexes was 138.9 per 100,000 in the population.
2012 Report on Cancer Statistics in Alberta
23
*†‡
Figure 2-11: Age-Standardized Incidence Rates (ASIRs),
Age-Standardized Mortality Rates
*†
(ASMRs), and 95% Confidence Intervals (CI) for All Cancers, Males, Alberta, 19922012
600
500
Rate per 100,000
400
ASIR
300
ASMR
200
100
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Year
* Three-year moving average.
† Standardized to 1991 Canadian population.
‡ Excludes basal and squamous skin cancers.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Male ASIRs for all cancers increased significantly between 1992 and 2001 by 0.9% annually and
decreased significantly between 2001 and 2012 by 1.0% annually (Figure 2-11). In 2012, the ASIR for all
cancers in males was 430.7 per 100,000 male population.
Male ASMRs for all cancers decreased significantly by 1.1% annually between 1992 and 2007 and by
2.7% annually between 2007 and 2012 (Figure 2-11). In 2012, the ASMR for all cancers in males was
165.09 per 100,000 male population.
2012 Report on Cancer Statistics in Alberta
24
*†‡
Figure 2-12: Age-Standardized Incidence Rates (ASIRs),
Age-Standardized Mortality Rates
*†
(ASMRs), and 95% Confidence Intervals (CI) for All Cancers, Females, Alberta, 19922012
600
500
Rate per 100,000
400
ASIR
ASMR
300
200
100
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Year
* Three-year moving average.
† Standardized to 1991 Canadian population.
‡ Excludes basal and squamous skin cancers.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Female ASIRs for all cancers increased significantly between 1992 and 2002 by 0.9% annually, but
decreased between 2002 and 2012 by 0.2% annually (Figure 2-12). In 2012, the ASIR for all cancers in
females was 361.5 per 100,000 female population.
Female ASMRs for all cancers decreased by 0.4% annually between 1992 and 2003. From 2003 to
2012, there was a further significant decrease by 2.0% annually (Figure 2-12). In 2012, the ASMR for all
cancers in females was 119.5 per 100,000 female population.
2012 Report on Cancer Statistics in Alberta
25
*†
Figure 2-13: Age-Standardized Incidence Rates (ASIRs) for Prostate Cancer, Breast Cancer
(Female), Lung Cancer (Male, Female), and Colorectal Cancer (Both Sexes Combined)
with 95% Confidence Intervals (CI), Alberta, 1992-2012
180
160
140
Rate per 100,000
120
100
80
60
40
20
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Year
Prostate
Male Lung
Female Lung
*
†
Female Breast
Male and Female Colorectal
Three-year moving average.
Standardized to 1991 Canadian population.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Prostate cancer ASIRs peaked in 2001. Over the time period 1992 to 1998, the prostate cancer ASIRs
decreased by 0.8% annually and increased between 1998 and 2001 by 10.6% annually. However, from
2001 to 2005 the prostate cancer ASIRs decreased by 6.4% annually and by 1.7% annually from 2005 to
2012. It has been speculated that the peak in 2001 was the result of increased PSA screening test activity
9, 10
after the Federal Minister of Health, Allan Rock, was diagnosed with prostate cancer
(Figure 2-13).
Female breast cancer ASIRs did not change significantly between 1992 and 2012 (Figure 2-13).
Male lung cancer ASIRs decreased by 1.5% annually between 1992 and 2012. Female lung cancer
ASIRs increased significantly by 1.9% annually between 1992 and 2006 then decreased between 2006
and 2012 by 0.4% annually (Figure 2-13).
Finally, colorectal cancer ASIRs increased significantly from 1992 to 2001 by 1.2% annually and
decreased by 0.4% annually between 2001 and 2012 (Figure 2-13).
2012 Report on Cancer Statistics in Alberta
26
Figure 2-14: Actual and Projected Number of New Cases and Age-Standardized Incidence Rates
*† ‡
(ASIRs) for All Cancer, Males, Alberta, 1992-2017
550
16000
500
14000
12000
400
350
300
250
200
4588 4866
4958 5073
5255 5251 5519
6005 6199
6754 6727
7032 7017 7027
7424 7587
7948 8181 8118
8651 8481
9137 9385
9674
10267
9963
10000
8000
New Cases
Rate per 100,000
450
6000
150
4000
100
2000
50
0
0
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
Alberta New Cases
Alberta Projected New Cases
Alberta 3-Year Moving Average ASIR
Alberta Projected ASIR
Canada ASIR
Canada Projected ASIR
* Three-year moving average.
† Standardized to 1991 Canadian population.
‡ Excludes basal and squamous skin cancers.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health; Canadian Cancer Society
In 2012, 8,481 cases of cancer were diagnosed in males in Alberta (Figure 2-14). ASIRs for cancer in
males in Alberta were lower than ASIRs in Canada between 1992 and 1994 and higher than ASIRs in
Canada over the period 1995-2005.
It is estimated that 10,250 cases of cancer will be diagnosed in males in Alberta in 2017.
2012 Report on Cancer Statistics in Alberta
27
Figure 2-15: Actual and Projected Number of New Cases and Age-Standardized Incidence Rates
*† ‡
ASIRs) for All Cancer, Females, Alberta, 1992-2017
550
16000
500
14000
12000
400
350
300
250
200
150
4153 4204
4393 4407
4761 5010
5117
5415 5576 5667
6149 6205
6419 6419 6692
6967 7055
7247 7507
7864 7849
8332 8507
9264
8750 9001
10000
8000
New Cases
Rate per 100,000
450
6000
4000
100
2000
50
0
0
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
Alberta New Cases
Alberta Projected New Cases
Alberta 3-Year Moving Average ASIR
Alberta Projected ASIR
Canada ASIR
Canada Projected ASIR
* Three-year moving average.
† Standardized to 1991 Canadian population.
‡ Excludes basal and squamous skin cancers.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health; Canadian Cancer Society
In 2012, 7,848 cases of cancer were diagnosed in females in Alberta (Figure 2-15). ASIRs for cancer in
females in Alberta were slightly higher than ASIRs for females in Canada between 1995 and 2008.
It is estimated that 9,250 cases of cancer will be diagnosed in females in Alberta in 2017.
2012 Report on Cancer Statistics in Alberta
28
Figure 2-16: Age-Specific Incidence Rates for All Cancers by Sex, Alberta, 2008-2012
*
3500
Rate per 100,000
3000
2500
2000
Male
1500
Female
1000
500
0
0
20
40
60
80
100
Age (Years)
*
Excludes basal and squamous skin cancers
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Cancer rates increase with age (Figure 2-16). In females, cancer rates remain very low until about the
age of 35 when they begin to increase. In males, cancer rates remain low until about the age of 40, at
which point they begin increasing rapidly. After the age of about 50, the age-specific cancer rates are
higher in males than females. In both males and females, the highest cancer incidence rates occur in the
oldest age groups.
2012 Report on Cancer Statistics in Alberta
29
*†
Figure 2-17: Age-Standardized Mortality Rates (ASMRs) for Lung Cancer (Male, Female),
Colorectal Cancer (Both Sexes Combined), Prostate Cancer, and Breast Cancer
(Female) with 95% Confidence Intervals (CI), Alberta, 1992-2012
80
Rate per 100,000
60
40
20
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Year
Prostate
Male Lung
Female Lung
*
†
Female Breast
Male and Female Colorectal
Three-year moving average.
Standardized to 1991 Canadian population.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
Between 1992 and 2012, prostate cancer ASMRs decreased significantly by 2.6% annually (Figure 217).
Breast cancer ASMRs in females decreased significantly between 1992 and 2012 by 3.0% annually
(Figure 2-17).
Male lung cancer ASMRs decreased significantly between 1992 and 2009 by 1.5% annually and by 5.9%
annually between 2009 and 2012 (Figure 2-17). Female lung cancer ASMRs increased significantly by
1.9% annually between 1992 and 2004. From 2004 to 2012, female lung cancer decreased by 0.8%
annually.
Over the period 1992 to 2012, colorectal cancer ASMRs decreased by 1.3% annually (Figure 2-17).
2012 Report on Cancer Statistics in Alberta
30
Figure 2-18: Actual and Projected Number of Deaths and Age-Standardized Mortality Rates
*†
(ASMRs) for All Cancers, Males, Alberta, 1992-2017
300
10000
9000
8000
7000
200
6000
150
Deaths
Rate per 100,000
250
5000
100
2116 2155 2160
2333 2310 2277 2380 2385 2504
2566
2882 2844 2943
2614 2691 2784
2976 3091 3017 2999 3113
3339 3445
3766
3547 3653
4000
3000
2000
50
1000
0
0
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
*
†
Alberta Deaths
Alberta Projected Deaths
Alberta 3-Year Moving Average ASMR
Alberta Projected ASMR
Canada ASMR
Canada Projected ASMR
Three-year moving average.
Standardized to 1991 Canadian population.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health; Canadian Cancer Society
In 2012, 3,113 males died of cancer in Alberta (Figure 2-18). ASMRs for all cancers in males in Alberta
were lower than ASMRs in Canada.
It is estimated that 3,750 males will die from cancer in Alberta in 2017.
2012 Report on Cancer Statistics in Alberta
31
Figure 2-19: Actual and Projected Number of Deaths and Age-Standardized Mortality Rates
*†
(ASMRs) for All Cancers, Females, Alberta, 1992-2017
300
10000
9000
8000
7000
200
6000
150
Deaths
Rate per 100,000
250
5000
4000
100
18121914 1859 1886
2119 2048 2064 2246 2275 2246
2376 2505 2511 2439
2582 2594 2665 2670 2635 2662 2704
3093
2881 2918 2974 3032
3000
2000
50
1000
0
0
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year
*
†
Alberta Deaths
Alberta Projected Deaths
Alberta 3-Year Moving Average ASMR
Alberta Projected ASMR
Canada ASMR
Canada Projected ASMR
Three-year moving average.
Standardized to 1991 Canadian population.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health; Canadian Cancer Society
In 2012, 2,704 females died of cancer in Alberta (Figure 2-19). ASMRs for all cancers in females in
Alberta were lower than ASMRs in Canada.
It is estimated that 3,100 females will die from cancer in Alberta in 2017.
2012 Report on Cancer Statistics in Alberta
32
Figure 2-20: Age-Specific Mortality Rates for All Cancers by Sex, Alberta, 2008-2012
3500
Rate per 100,000
3000
2500
2000
Male
Female
1500
1000
500
0
0
20
40
60
80
100
Age (Years)
Data Source: Alberta Cancer Registry, Alberta Health Services, Alberta Health
For both males and females, cancer mortality rates remain very low until about the age of 40, at which
point they begin increasing rapidly (Figure 2-20). After the age of 55, females have lower cancer
mortality rates than males. The highest cancer mortality rates occur in the oldest age groups.
2012 Report on Cancer Statistics in Alberta
33
Cancer Survival
Cancer survival ratios indicate the proportion of people who will be alive at a given time after they have
been diagnosed with cancer. Survival is an important outcome measure and is used for evaluating the
effectiveness of cancer treatment and control programs.
Survival depends on several factors including the cancer type (most importantly site, stage and
morphology at diagnosis), sex, age at diagnosis, health status and available treatments for that cancer.
While relative survival ratios (RSRs) give a general expectation of survival over the whole province,
these ratios may not apply to individual cases. Individual survival outcomes depend on the stage at
diagnosis, treatment and other individual circumstances.
Relative survival ratios are estimated by comparing the survival of cancer patients with that expected in
11
the general population of Albertans of the same age, sex and in the same calendar year . For common
cancer sites, RSRs are standardized by the age structure in the standard population (i.e. all persons who
were diagnosed with that cancer in Canada between 1992 and 2001) to permit RSRs to be compared
over time, independent of differences in age distribution of cancer cases. For cancer sites with fewer
case counts which do not permit age standardizing or those which are stratified by incidence stage, the
crude RSRs are provided.
11
RSRs are estimated by the cohort method when complete follow-up data (e.g., at least five years of
follow-up to estimate five-year rate) after diagnosis are available. For recently diagnosed cases, whose
complete follow-up data are not available, the up-to-date estimates are computed using the period
12
method . However, comparison between cohort and period RSRs should be interpreted with caution
because of the two different methods used to derive the respective ratios.
The relative survival ratio is usually expressed as a percentage (%) and the closer the value is to 100%,
the more similar the survival pattern is to the general population.
2012 Report on Cancer Statistics in Alberta
34
Figure 2-21: Age-Standardized One, Three and Five-Year Relative Survival Ratios and 95%
Confidence Intervals (CI) for Prostate, Lung and Colorectal Cancers, Males, Alberta,
*
2010-2012
100
Relative Survival (%)
80
60
Prostate
Lung
40
Colorectal
20
0
1 year
3 year
Years After Diagnosis
5 year
* Ratios calculated by period method where complete follow-up data are not available
Data Source: Alberta Cancer Registry, Alberta Health Services; Statistics Canada
The five-year relative survival ratios for males diagnosed with prostate, lung and colorectal cancers from
2010 to 2012 are 93%, 14% and 64%, respectively (Figure 2-21). This means that out of all males
diagnosed with prostate cancer between 2010 and 2012, around 93% are as likely to be alive five years
after diagnosis as males from the general Alberta population of the same age.
2012 Report on Cancer Statistics in Alberta
35
Figure 2-22: Age-Standardized One, Three and Five-Year Relative Survival Ratios and 95%
Confidence Intervals (CI) for Breast, Lung and Colorectal Cancers, Females, Alberta,
*
2010-2012
100
Relative Survival (%)
80
60
Breast
Lung
40
Colorectal
20
0
1 year
3 year
Years After Diagnosis
5 year
* Ratios calculated by period method where complete follow-up data are not available
Data Source: Alberta Cancer Registry, Alberta Health Services; Statistics Canada
The five-year relative survival ratios for females diagnosed with breast, lung and colorectal cancers are
90%, 19% and 65%, respectively (Figure 2-22). This means that females diagnosed with breast cancer in
2010 to 2012 are about 90% as likely to be alive for the following five years as women from the general
population of the same age. Females have a better five-year relative survival ratio (19%) for lung cancer
than males (14%). Survival in females diagnosed with lung cancer is still very low.
2012 Report on Cancer Statistics in Alberta
36
Table 2-7: Age-Standardized One-, Three- and Five-Year Relative Survival Ratios (%) and 95%
Confidence Intervals (CIs) for Selected Cancers Diagnosed Between 2010 and 2012 by
Sex, Alberta
Cancer type
Bladder
Body of Uterus
Breast
Colorectal
Kidney
Leukemia
Lung
Melanoma
Non-Hodgkin
Lymphoma
Prostate
1-year Relative Survival
Ratio (95% CI)
Male
Female
90 (88,92)
87 (83,90)
--93 (91,95)
--98 (97,98)
81 (80,83)
79 (77,81)
79 (76,82)
82 (78,85)
81 (78,84)
78 (74,82)
38 (36,40)
45 (43,47)
95 (93,96)
98 (97,99)
3-year Relative Survival
Ratio (95% CI)
Male
Female
82 (79,84)
79 (74,83)
--86 (84,88)
--94 (93,94)
70 (68,72)
69 (67,71)
71 (67,74)
75 (71,79)
76 (72,79)
73 (69,77)
19 (17,21)
25 (24,27)
89 (86,92)
97 (95,99)
5-year Relative Survival
Ratio (95% CI)
Male
Female
77 (74,80)
79 (74,84)
--83 (80,85)
--90 (89,91)
64 (61,66)
65 (63,67)
67 (63,70)
71 (67,75)
71 (67,75)
70 (66,75)
14 (12,16)
19 (18,21)
87 (83,89)
95 (93,98)
83 (80,85)
87 (85,90)
75 (72,77)
82 (79,84)
70 (67,74)
76 (73,79)
98 (97,99)
---
96 (95,97)
---
93 (92,95)
---
Data Source: Alberta Cancer Registry, Alberta Health Services; Statistics Canada
Survival ratios vary by type of cancers and sex (Table 2-7). Of the 10 most common cancers, lung cancer
patients have the lowest survival ratio whereas those diagnosed with prostate and breast cancers have
very high survival ratios. Survival is about the same in males and females for colorectal cancer. Survival
is greater in females than males for lung, kidney, melanoma of the skin and non-Hodgkin lymphoma.
Males have slightly greater survival than females for leukemia.
2012 Report on Cancer Statistics in Alberta
37
†
Table 2-8: Crude One-, Two- and Three-Year Relative Survival Ratios (%) for Colorectal, Lung,
Breast and Prostate Cancers by Stage and Sex, Alberta, 2009-2012.
Cancer
Type*
Stage
Colorectal
Lung
Breast
Prostate
‡
One-year Survival
Number of Cases
Rate (95% CI)
Two-year Survival
Rate (95% CI)
Three-year Survival
Rate (95% CI)
Male
Female
Male
Female
Male
Female
Male
Female
I
667
507
98 (96, 100)
98 (96, 99)
98 (95, 100)
97 (94, 99)
98 (95, 100)
97 (94, 100)
II
804
613
95 (93, 97)
95 (93, 97)
95 (92, 97)
93 (90, 96)
94 (90, 96)
93 (89, 96)
III
990
730
94 (92, 96)
92 (89, 94)
89 (87, 91)
86 (83, 89)
83 (80, 86)
81 (77, 84)
IV
821
615
48 (45, 52)
44 (40, 48)
30 (27, 33)
27 (24, 31)
19 (17, 22)
19 (16, 23)
I
398
538
87 (83, 90)
92 (90, 95)
75 (70, 79)
84 (80, 87)
64 (58, 69)
77 (73, 81)
II
207
198
81 (74, 86)
69 (62, 76)
56 (48, 63)
59 (51, 67)
45 (36, 54)
50 (41, 59)
III
588
608
48 (44, 52)
56 (52, 60)
26 (22, 29)
36 (33, 40)
16 (13, 19)
26 (23, 30)
IV
1852
1607
17 (16, 19)
21 (19, 23)
7 (6, 8)
10 (8, 11)
5 (4, 6)
5 (4, 7)
I
---
3523
---
100 (100, 100)
---
100 (100, 100)
---
100 (100, 100)
II
---
2664
---
100 (100, 100)
---
99 (98, 100)
---
98 (97, 99)
III
---
1010
---
97 (95, 98)
---
91 (89, 93)
---
86 (83, 88)
IV
---
394
---
68 (63, 72)
---
51 (45, 56)
---
39 (33, 44)
I
1403
---
100 (100, 100)
---
100 (100, 100)
---
100 (100, 100)
---
II
4847
---
100 (100, 100)
---
100 (100, 100)
---
100 (100, 100)
---
III
895
---
100 (100, 100)
---
100 (100, 100)
---
100 (100, 100)
---
IV
816
---
82 (79, 85)
---
64 (60, 68)
---
52 (47, 56)
---
* Inclusion criteria: First-primary invasive cancer and age 15 to 99 years at diagnosis.
†
Ratios calculated by period method, where complete follow-up data are not available
ⱡ The staging method changed in 2010 (from AJCC 6 to AJCC 7), so caution should be used when comparing to data from
previous reports.
Data Source: Alberta Cancer Registry, Alberta Health Services; Statistics Canada
Cancer stage (extent or severity of cancer) at diagnosis affects survival. Those diagnosed at an earlier
stage have better survival than those diagnosed at a later stage.
For colorectal cancers diagnosed between 2009 and 2012, there was little difference in the proportion of
cases in each stage. The three-year relative survival ratios for colorectal cancer at stage I and II are
estimated above 93%, which are significantly higher than those diagnosed with colorectal cancer at stage
IV (male 19% and female 19%) (Table 2-8). There is little difference between males and females.
Most lung cancer cases in Alberta for the same time period were diagnosed at the later stages (III & IV).
The estimated relative survival ratios, compared to the earlier stages (I & II), are low. Survival ratios are
lower among males than females at all stages of diagnosis.
The majority of females were diagnosed with early stage breast cancer (Stage I or II) and have a similar
survival pattern as the general population for the first three years. The three-year relative survival ratio for
those diagnosed at stage IV is much lower (39%) than that for those at stage I and II (Table 2-8).
In 2009 to 2012, the majority of prostate cancer cases were diagnosed at stage II and all males who were
diagnosed at stage I, II and III were alive three years after diagnosis. Even though the three-year relative
survival ratio for males diagnosed with prostate cancer at stage IV (52%) is lower than that for those
diagnosed at an earlier stage, it is higher than the survival ratios for other major cancers.
2012 Report on Cancer Statistics in Alberta
38
Geographic Variation
The geographic variation section illustrates how the observed rates in each health zone compare with the
provincial average. It also compares each zone to the rest of Alberta (excluding the zone of interest). The
age standardized incidence and mortality rates for each zone and the respective “rest of Alberta”
13
groupings are presented with their corresponding 95% confidence intervals . Any observed
differences in rates may be due to several factors such as regional differences in:





individual risk factors
prevention efforts
cancer screening
diagnostic activity
14
access to cancer care.
Figure 2-23: Five Health Zones in Alberta, 2012
Source: Alberta Health Services
2012 Report on Cancer Statistics in Alberta
39
†
Figure 2-24: Age-Standardized Incidence Rates (ASIRs) and 95% Confidence Intervals (CI) by
Zone for All Cancers, Males, Alberta, 2008-2012
550
ASIR per 100,000
500
Alberta
ASIR &
95% C.I.
450
400
350
300
South
Calgary
Central
Edmonton
North
Health Zone
Zone of Interest
†
Rest of Alberta
Standardized to 1991 Canadian population for age-specific rates in 2008-2012.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
There is no evidence that male ASIRs in the zones are higher or lower than the provincial average or the
“rest of Alberta” (excluding the zone of interest) (Figure 2-24).
2012 Report on Cancer Statistics in Alberta
40
†
Figure 2-25: Age-Standardized Incidence Rates (ASIRs) and 95% Confidence Intervals (CI) by
Zone for All Cancers, Females, Alberta, 2008-2012
550
ASIR per 100,000
500
450
400
Alberta
ASIR &
95% C.I.
350
300
South
Calgary
Central
Edmonton
North
Health Zone
Zone of Interest
† Standardized to 1991
Rest of Alberta
Canadian population for age-specific rates in 2008-2012.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
There is no evidence that female ASIRs in the zones are higher or lower than the provincial average or
the “rest of Alberta” (excluding the zone of interest) (Figure 2-25).
2012 Report on Cancer Statistics in Alberta
41
†
Figure 2-26: Age-Standardized Mortality Rates (ASMRs) and 95% Confidence Intervals (CI) by
Zone for All Cancers, Males, Alberta, 2008-2012
ASMR per 100,000
250
200
Alberta
ASMR &
95% C.I.
150
100
South
Calgary
Central
Edmonton
North
Health Zone
Zone of Interest
†
Rest of Alberta
Standardized to 1991 Canadian population for age-specific rates in 2008-2012.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
There is no evidence that male ASMRs in the zones are higher or lower than the provincial average;
however, the ASMR in Calgary Zone is significantly lower than that in the “rest of Alberta” (excluding the
zone of interest) (Figure 2-26).
2012 Report on Cancer Statistics in Alberta
42
*
Figure 2-27: Age-Standardized Mortality Rates (ASMRs) and 95% Confidence Intervals (CI) by
Zone for All Cancers, Females, Alberta, 2008-2012
250
ASMR per 100,000
200
150
Alberta
ASMR &
95% C.I.
100
South
Calgary
Central
Edmonton
North
Health Zone
Zone of Interest
† Standardized to 1991
Rest of Alberta
Canadian population for age-specific rates in 2008-2012.
Data Source: Alberta Cancer Registry, Alberta Health Services; Alberta Health
There is no evidence that female ASMRs in the zones are higher or lower than the provincial average or
the “rest of Alberta” (excluding the zone of interest) (Figure 2-27).
2012 Report on Cancer Statistics in Alberta
43
Further Information
Further information is available on a separate document, the Appendix:
Appendix 1: Glossary of Terms
Appendix 2: Cancer Definitions
Appendix 3: Data Notes
2012 Report on Cancer Statistics in Alberta
44
References
1. Surveillance and Reporting, C-MORE, Cancer Control, Alberta Health Services. Report on
Cancer Statistics in Alberta 2010. Available from: http://www.albertahealthservices.ca/poph/hipoph-surv-cancer-cancer-in-alberta-2010.pdf
2. Service Alberta [Internet]. Canada. Government of Alberta. Alberta Vital Statistics Annual Review
2012 [cited 2014 Nov 6]; [PDF files]. Available from:
http://www.servicealberta.gov.ab.ca/1164.cfm
3. 2012 Alberta Population Data [Excel Spreadsheet]. Edmonton (Alberta): Alberta Health; 2014.
4. Statistics Canada [Internet]. Canada. Government of Canada. CANSIM. Table 052-0005 Projected population, by projection scenario, age and sex, as of July 1, Canada, provinces and
territories, annual (persons × 1,000)[cited 2014 Nov 6]; Available from:
http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=0520005&pattern=052&tabM
ode=dataTable&srchLan=-1&p1=1&p2=-1
5. Burnet NG, Jefferies SJ, Benson RJ, Hunt DP and Treasure FP. Years of life lost (YLL) from
cancer is an important measure of population burden--and should be considered when allocating
research funds. Br. J. Cancer. 2005; 92 (2): 241-245.
6. Okamoto N, Morio S, Inoue R and Akiyama K. The risk of a second primary cancer occurring in
five-year survivors of an initial cancer. Jpn. J Clin Oncol. 1987; 17(3):205-213.
7. National Cancer Institute - Surveillance Epidemiology and End Results [Internet]. USA. National
Institutes of Health; Cancer Prevalence Statistics Overview; 2014 Apr 10 [cited 2014 Nov 6];
Available from: http://surveillance.cancer.gov/prevalence
8. Kim H-J, Fay M and Feuer E. Permutation tests for JoinPoint regression with applications to
cancer rates. Stat. Med. 2000; 19:335-351.
9. Fradet Y, Klotz L, Trachtenberg J, and Zlotta A. The burden of prostate cancer in Canada. Can
Urol. Assoc J. 2009; 3(3 suppl 2):S92–S100.
10. Neutel CI, Gao R, Blood PA and Gaudette LA. Trends in prostate cancer incidence, hospital
utilization and surgical procedures, Canada, 1981-2000. Can J Public Health. 2006; 97(3):177–
182.
11. Ederer F, Axtell LM and Cutler SJ. The relative survival rate: a statistical methodology. Natl
Cancer Inst Monogr, 1961; 6: 101–121.
12. Brennera H, Gefellerb O and Hakulinen T. Period analysis for ‘up-to-date’ cancer survival data:
theory, empirical evaluation, computational realisation and applications. European Journal of
Cancer, 2004; 40: 326–335.
13. Fay MP and Feuer EJ. Confidence intervals for directly standardized rates: a method based on
the gamma distribution. Stat Med, 1997; 16: 791 – 801.
14. Levi F. Cancer Prevention: Epidemiology and Perspectives. Eur J Cancer. 1999; 35(7):10461058.
2012 Report on Cancer Statistics in Alberta
45
Contact Information
If further information is required, please contact Surveillance & Reporting, C-MORE, Alberta Health
Services as follows:
Mailing
Address:
Alberta Health Services
Surveillance & Reporting
C-MORE
1400 - 10123-99 Street
Edmonton, AB, Canada
T5J 3H1
Phone:
Fax:
Email:
780-643-4347
780-643-4380
[email protected]
2012 Report on Cancer Statistics in Alberta
46